National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- (-) Cardiovascular Conditions (16)
- Chronic Conditions (1)
- Comparative Effectiveness (2)
- Data (2)
- Elderly (4)
- Evidence-Based Practice (1)
- Healthcare-Associated Infections (HAIs) (1)
- Healthcare Costs (1)
- Healthcare Utilization (2)
- Health Insurance (1)
- Heart Disease and Health (9)
- Hospitalization (1)
- Hospital Readmissions (2)
- Hospitals (3)
- Inpatient Care (1)
- Medical Devices (2)
- (-) Medicare (16)
- Mortality (3)
- Outcomes (4)
- Patient-Centered Healthcare (1)
- Patient-Centered Outcomes Research (3)
- Payment (4)
- Pneumonia (2)
- Policy (1)
- Provider Performance (3)
- Quality Measures (1)
- Quality of Care (1)
- Racial and Ethnic Minorities (1)
- Registries (3)
- Rehabilitation (1)
- Risk (1)
- Sex Factors (1)
- Surgery (3)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 16 of 16 Research Studies DisplayedMeddings J, Smith SN, Hofer TP
Mixed messages to consumers from Medicare: Hospital Compare grades versus value-based payment penalty.
This study examined the discrepancy of ratings with hospitals with low readmission grades for heart failure (HF) and acute myocardial infarction (AMI) on the Hospital Compare website, yet received penalties for excessive readmissions under the hospital Readmissions Reduction Program. A retrospective data analysis was conducted of 2956 hospitals that had publicly reported HF grades on Hospital Compare. Of those, 92% were graded as “no different” than the national rate for HD readmissions, yet included 48.6% that were scored as having excessive HF admissions and 87% received an overall readmission penalty. Of the 120 hospitals graded as “better”, none were scored as having excessive HF readmissions and 50% were penalized. There were similar results for AMI.
AHRQ-funded; HS018334; HS019767.
Citation: Meddings J, Smith SN, Hofer TP .
Mixed messages to consumers from Medicare: Hospital Compare grades versus value-based payment penalty.
Am J Manag Care 2018 Dec;24(12):e399-e403..
Keywords: Medicare, Hospital Readmissions, Heart Disease and Health, Hospitals, Quality of Care, Cardiovascular Conditions, Provider Performance, Payment
Huckfeldt P, Escarce J, Wilcock A
HF mortality trends under Medicare readmissions reduction program at penalized and nonpenalized hospitals.
After announcement and implementation of the Medicare Hospital Readmissions Reduction Program (HRRP), 30-day readmissions declined rapidly among seniors with heart failure (HF) while 30-day mortality rose. This raised questions about whether the policy was responsible, because lower HF readmission rates have historically been associated with higher mortality. In this study, the investigators compared trends in heart failure (HF) mortality at penalized and nonpenalized hospitals nationally.
AHRQ-funded; HS024284.
Citation: Huckfeldt P, Escarce J, Wilcock A .
HF mortality trends under Medicare readmissions reduction program at penalized and nonpenalized hospitals.
J Am Coll Cardiol 2018 Nov 13;72(20):2539-40. doi: 10.1016/j.jacc.2018.08.2174..
Keywords: Mortality, Heart Disease and Health, Cardiovascular Conditions, Hospital Readmissions, Medicare, Hospitals, Provider Performance, Payment
Desai NR, Ott LS, George EJ
Variation in and hospital characteristics associated with the value of care for Medicare beneficiaries with acute myocardial infarction, heart failure, and pneumonia.
The objectives of this study were to investigate the association between hospital-level 30-day risk-standardized mortality rates (RSMRs) and 30-day risk-standardized payments (RSPs) for acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PNA); to characterize patterns of value in care; and to identify hospital characteristics associated with high-value care (defined by having lower than median RSMRs and RSPs).
AHRQ-funded; HS023000.
Citation: Desai NR, Ott LS, George EJ .
Variation in and hospital characteristics associated with the value of care for Medicare beneficiaries with acute myocardial infarction, heart failure, and pneumonia.
JAMA Netw Open 2018 Oct 5;1(6):e183519. doi: 10.1001/jamanetworkopen.2018.3519..
Keywords: Cardiovascular Conditions, Elderly, Hospitalization, Hospitals, Heart Disease and Health, Inpatient Care, Medicare, Mortality, Pneumonia
Rymer JA, Chen AY, Thomas L
Advanced practice provider versus physician-only outpatient follow-up after acute myocardial infarction.
This study examines the prevalence of using advanced practice providers (APPs) for care following myocardial infarction as opposed to physicians due to physician shortages and reimbursement changes. Outpatient cardiology or primary care visits within 90 days of MI among 29,477 Medicare-insured patients aged 65 or older from 364 hospitals were examined from data in the Acute Coronary Treatment Intervention Outcomes Network Registry. Medicare adherence, all-cause readmission risk, mortality, and major adverse cardiovascular events were compared for patients seen by APPs versus physicians only. Patients seen by APPs were more likely to have diabetes mellitus, heart failure, be discharged to a nursing facility, and had more outpatient visits. There was no differences in the factors listed between patients seen by APPs or physicians. Patients seen by APPs were in more need of frequent monitoring and were more likely to have other chronic conditions leading to higher risk of post-MI complications.
AHRQ-funded; HS021092.
Citation: Rymer JA, Chen AY, Thomas L .
Advanced practice provider versus physician-only outpatient follow-up after acute myocardial infarction.
J Am Heart Assoc 2018 Sep 4;7(17):e008481. doi: 10.1161/jaha.117.008481..
Keywords: Cardiovascular Conditions, Elderly, Heart Disease and Health, Medicare, Outcomes, Patient-Centered Outcomes Research, Registries
Thompson MP, Cabrera L, Strobel RJ
Association between postoperative pneumonia and 90-day episode payments and outcomes among Medicare beneficiaries undergoing cardiac surgery.
Postoperative pneumonia is the most common healthcare-associated infection in cardiac surgical patients, yet their impact across a 90-day episode of care remains unknown. The objective of this study was to examine the relationship between pneumonia and 90-day episode payments and outcomes among Medicare beneficiaries undergoing cardiac surgery. The investigators concluded that postoperative pneumonia was associated with significantly higher 90-day episode payments and inferior outcomes at the patient and hospital level.
AHRQ-funded; HS022535.
Citation: Thompson MP, Cabrera L, Strobel RJ .
Association between postoperative pneumonia and 90-day episode payments and outcomes among Medicare beneficiaries undergoing cardiac surgery.
Circ Cardiovasc Qual Outcomes 2018 Sep;11(9):e004818. doi: 10.1161/circoutcomes.118.004818..
Keywords: Elderly, Surgery, Medicare, Cardiovascular Conditions, Heart Disease and Health, Pneumonia, Payment, Healthcare Costs, Outcomes, Healthcare-Associated Infections (HAIs), Health Insurance
Sinha SS, Moloci NM, Ryan AM
The effect of Medicare accountable care organizations on early and late payments for cardiovascular disease episodes.
In this study, the investigators examined the association between Medicare accountable care organization (ACO) implementation and episode spending for 2 different cardiovascular conditions. The investigators found that for beneficiaries with acute myocardial infarction or congestive heart failure, admission to ACO participating hospitals was not associated with changes in early episode spending, but it was associated with significant savings during the late episode. ACO effects on late episode spending may complement other value-based payment reforms that target the early episode.
AHRQ-funded; HS024728; HS024525.
Citation: Sinha SS, Moloci NM, Ryan AM .
The effect of Medicare accountable care organizations on early and late payments for cardiovascular disease episodes.
Circ Cardiovasc Qual Outcomes 2018 Aug;11(8):e004495. doi: 10.1161/circoutcomes.117.004495..
Keywords: Cardiovascular Conditions, Payment, Medicare
Angraal S, Khera R, Wang Y
Sex and race differences in the utilization and outcomes of coronary artery bypass grafting among Medicare beneficiaries, 1999-2014.
The authors sought to evaluate how the use of coronary artery bypass grafting (CABG) and its outcomes have evolved in different sex and racial subgroups. Using Medicare data, they found that women and black patients had persistently higher CABG mortality than men and white patients, respectively, despite greater declines over the time period. The authors conclude that these findings indicate progress, but further progress is needed.
AHRQ-funded; HS023000.
Citation: Angraal S, Khera R, Wang Y .
Sex and race differences in the utilization and outcomes of coronary artery bypass grafting among Medicare beneficiaries, 1999-2014.
J Am Heart Assoc 2018 Jul 12;7(14). doi: 10.1161/jaha.118.009014..
Keywords: Cardiovascular Conditions, Elderly, Evidence-Based Practice, Heart Disease and Health, Healthcare Utilization, Medicare, Outcomes, Patient-Centered Outcomes Research, Racial and Ethnic Minorities, Sex Factors
Desai NR, Bourdillon PM, Parzynski CS
Association of the US Department of Justice Investigation of Implantable Cardioverter-Defibrillators and
The US Department of Justice (DOJ) conducted an investigation into implantable cardioverter-defibrillators (ICDs) not meeting the Centers for Medicare & Medicaid Services National Coverage Determination (NCD) criteria. To examine changes in the proportion of initial primary prevention ICDs that did not meet NCD criteria following the announcement of the DOJ investigation at hospitals that reached settlements (settlement hospitals) and those that did not (nonsettlement hospitals).
AHRQ-funded; HS023000.
Citation: Desai NR, Bourdillon PM, Parzynski CS .
Association of the US Department of Justice Investigation of Implantable Cardioverter-Defibrillators and
JAMA 2018 Jul 3;320(1):63-71. doi: 10.1001/jama.2018.8151..
Keywords: Cardiovascular Conditions, Medical Devices, Medical Devices, Medicare, Policy
Hollingsworth JM, Nallamothu BK, Yan P
Medicare accountable care organizations are not associated with reductions in the use of low-value coronary revascularization.
This study examined national Medicare data to determine whether or not Medicare accountable care organizations are associated with reductions in the use of low-value coronary revascularization. The investigators found no association between provider group participation in a Medicare ACO and use of low- or high-value coronary revascularization.
AHRQ-funded; HS024525; HS024728.
Citation: Hollingsworth JM, Nallamothu BK, Yan P .
Medicare accountable care organizations are not associated with reductions in the use of low-value coronary revascularization.
Circ Cardiovasc Qual Outcomes 2018 Jun;11(6):e004492. doi: 10.1161/circoutcomes.117.004492..
Keywords: Cardiovascular Conditions, Healthcare Utilization, Medicare, Heart Disease and Health
Suckow BD, Goodney PP, Columbo JA
National trends in open surgical, endovascular, and branched-fenestrated endovascular aortic aneurysm repair in Medicare patients.
Open repair effectively prevents rupture for patients with abdominal aortic aneurysm (AAA) and is commonly studied as a metric reflecting hospital and surgeon expertise in cardiovascular care. However, given recent advances in endovascular aneurysm repair (EVAR), such as branched-fenestrated EVAR, it is unknown how commonly open surgical repair is still used in everyday practice. This study analyzed trends in open AAA repair, EVAR, and branched-fenestrated EVAR for AAA in Medicare beneficiaries from 2003 to 2013.
AHRQ-funded; HS021581.
Citation: Suckow BD, Goodney PP, Columbo JA .
National trends in open surgical, endovascular, and branched-fenestrated endovascular aortic aneurysm repair in Medicare patients.
J Vasc Surg 2018 Jun;67(6):1690-97.e1. doi: 10.1016/j.jvs.2017.09.046..
Keywords: Cardiovascular Conditions, Medicare, Provider Performance, Quality Measures, Surgery
Beatty AL, Truong M, Schopfer DW
Geographic variation in cardiac rehabilitation participation in Medicare and veterans affairs populations: opportunity for improvement.
The authors sought to evaluate variation in cardiac rehabilitation participation across the United States. They found that, overall, participation in cardiac rehabilitation was 16.3% in Medicare and 10.3% in VA. Patients in the West North Central region had the highest participation, whereas those in the Pacific region had the lowest participation. Significant hospital-level variation was also present.
AHRQ-funded; HS022990.
Citation: Beatty AL, Truong M, Schopfer DW .
Geographic variation in cardiac rehabilitation participation in Medicare and veterans affairs populations: opportunity for improvement.
Circulation 2018 May 1;137(18):1899-908. doi: 10.1161/circulationaha.117.029471.
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Keywords: Cardiovascular Conditions, Medicare, Patient-Centered Healthcare, Rehabilitation
Liang Q, Ward S, Pagani FD
Linkage of Medicare records to the interagency registry of mechanically assisted circulatory support.
This study merged Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) records with CMS Medicare claims regarding adults receiving durable FDA-approved mechanical circulatory support devices (MCSDs) in order to investigate the uncertainty of penetrance of Medicare beneficiaries within INTERMACS. The results indicated that there was an annual increase in CMS and INTERMACS centers performing durable MCSD implants among adults from 2008 to 2013, but the CMS centers outnumbered the INTERMAC centers throughout this period. Representation within INTERMACS of MCSDs implanted in Medicare beneficiaries more than doubled in 2013. The authors conclude that ‘the vast majority’ of Medicare beneficiaries receiving MCSDs are increasingly captured in INTERMACS, and that contemporary studies in INTERMACS are therefore relevant and generalizable to the Medicare population.
AHRQ-funded; HS022535.
Citation: Liang Q, Ward S, Pagani FD .
Linkage of Medicare records to the interagency registry of mechanically assisted circulatory support.
Ann Thorac Surg 2018 May;105(5):1397-402. doi: 10.1016/j.athoracsur.2017.11.044..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Data, Medicare, Registries
Liang Q, Ward S, Pagani FD
Linkage of Medicare records to the interagency registry of mechanically assisted circulatory support.
This study merged Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) records with CMS Medicare claims regarding adults receiving durable FDA-approved mechanical circulatory support devices (MCSDs) in order to investigate the uncertainty of penetrance of Medicare beneficiaries within INTERMACS. The results indicated that there was an annual increase in CMS and INTERMACS centers performing durable MCSD implants among adults from 2008 to 2013, but the CMS centers outnumbered the INTERMAC centers throughout this period. Representation within INTERMACS of MCSDs implanted in Medicare beneficiaries more than doubled in 2013. The authors conclude that ‘the vast majority’ of Medicare beneficiaries receiving MCSDs are increasingly captured in INTERMACS, and that contemporary studies in INTERMACS are therefore relevant and generalizable to the Medicare population.
AHRQ-funded; HS022535.
Citation: Liang Q, Ward S, Pagani FD .
Linkage of Medicare records to the interagency registry of mechanically assisted circulatory support.
Ann Thorac Surg 2018 May;105(5):1397-402. doi: 10.1016/j.athoracsur.2017.11.044..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Data, Medicare, Registries
Bilchick KC, Stukenborg GJ
Comparative effectiveness of cardiac resynchronization therapy in combination with implantable defibrillator in patients with heart failure and wide QRS duration.
The researchers examined the long-term outcomes among Medicare patients with cardiac resynchronization therapy defibrillators (CRT-D) compared with those receiving standard implantable cardioverter defibrillators. They found that the greatest benefit of CRT-D was in patients with guideline-based class I recommendations for CRT-D. For these patients, there was a 17 percent reduction in risk of death.
AHRQ-funded; HS017693
Citation: Bilchick KC, Stukenborg GJ .
Comparative effectiveness of cardiac resynchronization therapy in combination with implantable defibrillator in patients with heart failure and wide QRS duration.
Am J Cardiol. 2014 Nov 15;114(10):1537-42. doi: 10.1016/j.amjcard.2014.08.017..
Keywords: Comparative Effectiveness, Medicare, Outcomes, Cardiovascular Conditions, Medical Devices
Du DT, McKean SJ, Kelman JA, et al.
AHRQ Author: Encinosa W
Early mortality after aortic valve replacement with mechanical prosthetic vs bioprosthetic valves among Medicare beneficiaries: a population-based cohort study.
The researchers compared early mortality after aortic valve replacement (AVR) between the recipients of mechanical and bioprosthetic aortic valves. Among 66,453 Medicare beneficiaries who received AVRs, use of mechanical valves was associated with a higher risk for death on the date of surgery and within 30 days compared with the bioprosthetic aortic valves. However, this applied only to those who underwent concurrent AVR and coronary artery bypass graft but not isolated AVR.
AHRQ-authored
Citation: Du DT, McKean SJ, Kelman JA, et al..
Early mortality after aortic valve replacement with mechanical prosthetic vs bioprosthetic valves among Medicare beneficiaries: a population-based cohort study.
JAMA Intern Med. 2014 Nov;174(11):1788-95. doi: 10.1001/jamainternmed.2014.4300..
Keywords: Cardiovascular Conditions, Medicare, Mortality, Patient-Centered Outcomes Research, Surgery
Thacker EL, Muntner P, Zhao H
Claims-based algorithms for identifying Medicare beneficiaries at high estimated risk for coronary heart disease events: a cross-sectional study.
The researchers sought to develop claims-based algorithms to identify individuals at high risk for coronary artery disease (CHD) and to identify low-density lipoprotein (LDL) cholesterol among statin users at high risk for CHD events. They found that despite low sensitivity, the high predictive value of their algorithm for high risk for CHD events supports the use of claims to identify Medicare beneficiaries at high risk for CHD events.
AHRQ-funded; HS018517
Citation: Thacker EL, Muntner P, Zhao H .
Claims-based algorithms for identifying Medicare beneficiaries at high estimated risk for coronary heart disease events: a cross-sectional study.
BMC Health Serv Res. 2014 Apr 29;14:195. doi: 10.1186/1472-6963-14-195..
Keywords: Comparative Effectiveness, Medicare, Risk, Cardiovascular Conditions, Chronic Conditions